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Lee JK, Mitchell PJ, Ang SB, Mercado-Asis LB, Rey-Matias R, Li J, Flicker L, Leung E, Choon D, Chandrasekaran SK, Close JCT, Seymour H, Cooper C, Halbout P, Blank RD, Zhao Y, Malhotra R, Unnanuntana A, Woo YL, Noor Z, Yang RS, Tabu I, Islam SS, Chinoy MA, Pande S, Thapa B, Wong RMY, Pande K, Chan DCD. Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association. Arch Osteoporos 2024; 19:24. [PMID: 38565791 DOI: 10.1007/s11657-024-01375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific. PURPOSE Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022. METHODS The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services. RESULTS In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service. CONCLUSION A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region.
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Affiliation(s)
- Joon Kiong Lee
- Beacon Hospital, Department of Orthopedics, Petaling Jaya, Malaysia.
| | - Paul James Mitchell
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Synthesis Medical NZ Limited, Dunedin, Otago, New Zealand
| | - Seng Bin Ang
- Asian Federation of Osteoporosis Societies, c/o, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
- Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Leilani Basa Mercado-Asis
- Asian Federation of Osteoporosis Societies, c/o, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
- University of Santo Tomas, Faculty of Medicine and Surgery and Public Health Program, Department of Medicine, Section of Endocrinology and Metabolism, Manila, Philippines
| | - Reynaldo Rey-Matias
- Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China
- Department of Physical and Rehabilitation Medicine, St. Luke's Medical Center, Quezon City, Philippines
- Philippine Academy of Rehabilitation Medicine, Manila, Philippines
| | - Jianan Li
- Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China
- College of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
- First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Leon Flicker
- Asia Pacific Geriatric Network, virtual network, Perth, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Edward Leung
- Asia Pacific Geriatric Network, virtual network, Perth, Australia
- Geriatric Medicine Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong SAR, China
| | - David Choon
- Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sankara Kumar Chandrasekaran
- Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jacqueline Clare Therese Close
- Fragility Fracture Network, Reinacherstrasse 131, 4053, Basel, Switzerland
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Seymour
- Fragility Fracture Network, Reinacherstrasse 131, 4053, Basel, Switzerland
- Department of Geriatrics and Aged Care, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Cyrus Cooper
- International Osteoporosis Foundation, Nyon, Switzerland
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Robert Daniel Blank
- International Society for Clinical Densitometry, Middletown, CT, USA
- Osteoporosis and Translational Research Laboratory, Garvan Institute of Medical Research, Sydney, Australia
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Yanling Zhao
- International Society for Clinical Densitometry, Middletown, CT, USA
- Beijing United Family Hospital (Department of Obstetrics and Gynecology), Beijing, China
| | - Rajesh Malhotra
- Department of Orthopaedics, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Zairin Noor
- Department of Orthopaedic and Traumatology, Ulin General Hospital, Banjarmasin, Indonesia
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University & Hospital, Taipei, Taiwan
| | - Irewin Tabu
- Department of Orthopedics, University of the Philippines-Philippine General Hospital, Manila, Philippines
- Institute on Aging, National Institutes of Health, UP Manila, Manila, Philippines
| | - Syed Shahidul Islam
- Department of Orthopaedics and Spine Surgery, Evercare Hospital, Dhaka, Bangladesh
| | - Muhammad Amin Chinoy
- Department of Trauma and Orthopaedics, The Indus Hospital, Korangi Crossing, Karachi, Pakistan
| | | | - Buland Thapa
- Department of Orthopaedics and Trauma, Nepal Academy of Science and Technology, Bir Hospital, Kathmandu, Nepal
| | - Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ketan Pande
- Department of Orthopaedics, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
- Jerudong Park Medical Centre, Brunei-Muara District, Brunei Darussalam
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong BE1410, Brunei Darussalam
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Miller PE, Murphy EP, Murphy R, Doran C, McKenna D, Murphy B, Doyle R, Hurson C. Does previous fragility fracture impact upon mortality in a hip fracture cohort? a retrospective study. Ir J Med Sci 2023; 192:2243-2249. [PMID: 36715792 DOI: 10.1007/s11845-022-03267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fragility fractures are described as fractures resulting from low-energy trauma and are considered diagnostic of reduced bone mineral density or osteoporosis. They often present as hip fractures with hip fractures remaining a common but devastating injury among older patients. Many factors influence a patient's risk of hip fracture and their subsequent risk of death. AIM In this study, we examined if previous fragility fracture impacts upon mortality after hip fracture. METHODS This was a retrospective single-center cohort study of patients included in the Irish Hip Fracture registry over a 5-year time period. Epidemiological data including gender, age, type of fracture, type of surgery, bone protection medication, American Society of Anesthetics (ASA) grade, and post-fracture outcomes including death at 30 days and death at 1 year were recorded. The presence or absence of a previous fragility fracture was examined to explore if a previous fragility fracture was an independent predictor of mortality. RESULTS There were 964 patients included, and 290 of whom had sustained a previous fragility fracture; 289 patients were males and 675 females, 33 patients had died in the 30 days following their surgery, and 180 patients had died within 1 year. We found statistically significant results for gender and age but not for previous fragility fracture influencing mortality (p value 0.230). CONCLUSION We found that previous fragility fracture does not impact upon mortality in a hip fracture cohort. However, gender and age did impact upon mortality in this study.
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Affiliation(s)
- Peggy E Miller
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
- University Hospital Waterford, Waterford City, Ireland.
| | | | | | - Charlotte Doran
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Daniel McKenna
- Royal College of Surgeons, 123 St Stephen's Green, Dublin, 2, Ireland
| | - Ben Murphy
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Rachael Doyle
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Conor Hurson
- St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
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Corrao G, Biffi A, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML. Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021. Front Endocrinol (Lausanne) 2023; 14:1137671. [PMID: 37143730 PMCID: PMC10151776 DOI: 10.3389/fendo.2023.1137671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field. Purpose This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline. Methods The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations. Results Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively. Conclusions The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luisella Cianferotti
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Maria Luisa Brandi
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
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Zhuang H, Lin S, Li Y, Cai S, Wang P, Yu H, Lin J, Yao X, Xu H. Educational program for orthopedic surgeons' influences for osteoporosis. Open Med (Wars) 2021; 16:1438-1443. [PMID: 34676303 PMCID: PMC8483061 DOI: 10.1515/med-2021-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 08/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background In this retrospective study, we studied the impact of educational osteoporosis program on the rates of bone mineral density (BMD) assessment and bone turnover markers (BTM) and drug medications in the patients with hip fracture. Methods This retrospective research enrolled 651 patients aged ≥50 years who experienced hip fractures from January 2013 to December 2015. We recorded whether patients had received BMD assessment, BTM measurement, and anti-osteoporosis therapy during the period of hospitalization. Orthopedic surgeons were classified into the trained group and the untrained group. The rates of BMD assessment, BTM measurement, and anti-osteoporosis medications in the patients with hip fracture were compared between the trained group and the untrained group. Results BMD assessment was performed in 109/220 patients in the trained group and 142/431 patients in the untrained group. BTM measurements were performed in 130 patients in the trained group and 124 patients in the untrained group. Forty eight patients in the trained group and 63 patients in the untrained group received bisphosphonate medications. Conclusions Although the rates of BMD assessment, BTM measurement, and bisphosphonate use in the patients after hip fractures are still insufficient, education programs help to improve the situation.
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Affiliation(s)
- Huafeng Zhuang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Shufeng Lin
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Yizhong Li
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Siqing Cai
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Peiwen Wang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Haiming Yu
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Jinkuang Lin
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Xuedong Yao
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
| | - Hao Xu
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, Fujian 362000, China
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Ross BJ, Lee OC, Harris MB, Dowd TC, Savoie FH, Sherman WF. Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures. JB JS Open Access 2021; 6:JBJSOA-D-20-00142. [PMID: 34136740 PMCID: PMC8202643 DOI: 10.2106/jbjs.oa.20.00142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Fragility fractures are often sentinel events in documenting new cases of osteoporosis. Numerous analyses have demonstrated low rates of adequate osteoporosis evaluation and treatment following primary fragility fractures. The purpose of this study was to quantify the incidence of primary fragility fractures in America and the rates of osteoporosis screening and management before and after fracture.
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Affiliation(s)
- Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas C Dowd
- Department of Orthopaedic Surgery, San Antonio Uniformed Services Health Education Consortium Orthopaedic Residency Program, Fort Sam Houston, Texas
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Carli AV, Gkiatas I, Bauer TW, Wright TM, Gonzalez FQ, Sculco PK. Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty. Arthroplast Today 2021; 7:188-193. [PMID: 33553548 PMCID: PMC7856391 DOI: 10.1016/j.artd.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/06/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022] Open
Abstract
Early periprosthetic fractures after total knee arthroplasty are rare but devastating complications which require revision surgery and lead to poor patient satisfaction. We present 2 siblings who underwent primary total knee arthroplasty on the same day and then both presented 2 weeks after surgery with atraumatic periprosthetic femur fractures. The first patient underwent revision for a cemented distal femoral replacement with stemmed tibial fixation. The second patient underwent an isolated femoral component revision with a stemmed femoral component and distal augment. Histological evaluation identified significant peri-implant osteoporosis. The variation in complexity associated with early periprosthetic femoral insufficiency fractures is highlighted by these 2 cases. Surgeons may consider using stemmed femoral components in similar patients if poor distal femoral bone stock is encountered intraoperatively.
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Affiliation(s)
- Alberto V Carli
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Comparison of morbidity and mortality of hip and vertebral fragility fractures: Which one has the highest burden? Osteoporos Sarcopenia 2020; 6:146-150. [PMID: 33102809 PMCID: PMC7573502 DOI: 10.1016/j.afos.2020.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives Hip fragility fractures were regarded as one of the most severe, but recent papers report on the underestimated burden of vertebral compression fractures. This study aims to compare morbidity and mortality of hip and vertebral fragility fractures in patients treated in the same setting. Methods Patients aged ≥50 years with hip fracture, and those with vertebral fracture presenting to our hospital between January 2014 and January 2017 were included. Patients were evaluated 1 year after their index fracture. SF-36 scores, mortality, and institutionalization are then recorded. Patients were divided into 2 groups: hip fractures and vertebral fractures. Results There were 106 and 90 patients respectively evaluated in hip and vertebral fracture groups at 1 year. Patients in both groups were comparable for age, sex, comorbidities and neuropsychiatric condition (P > 0.05). At 1 year follow-up, SF-36 showed better averages in all 8 scales in hip fracture group compared to vertebral fracture group. Mortality in the hip fracture group reached 32.1% compared to 10% for the vertebral fracture group (P < 0.01). Fifteen patients were institutionalized in the hip fracture group compared to 18 patients in the vertebral fracture group (P > 0.05). Conclusions When comparing patients treated in the same setting, hip fracture is associated with significantly increased mortality than vertebral fracture; however, the latter is associated with more morbidity.
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Xie C, Mu X, Hu Z, Wang W, Huang W, Huang G, Wang C, Yin D. Impact of pharmaceutical care in the orthopaedic department. J Clin Pharm Ther 2019; 45:401-407. [PMID: 31800132 DOI: 10.1111/jcpt.13091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In the mid-1960s, clinical pharmacy developed in the USA, and as the demand for pharmaceutical services continued to grow, their impact began to be taken seriously. However, the participation of clinical pharmacists as members of the multidisciplinary team in the orthopaedic department is still in its infancy, although its role in orthopaedics has not been defined. The object of this study was to identify and discuss the impact of pharmaceutical care in the orthopaedic department. METHODS A literature search was conducted on MEDLINE, PubMed, Web of Science, the Cochrane Library and CNKI (China National Knowledge Infrastructure) for papers published between 1998 and 2019, using the keywords pharmacy, pharmacist, and medication or drug combined with orthopaedic. Other available resources were also used to identify relevant articles. RESULTS AND DISCUSSION Based on the available evidence in 74 articles, it was found that clinical pharmacists play an important role in all aspects of rational use of medications, medication review and reconciliation, monitoring adverse drug events, risk assessment, and medication education and counselling. In addition, clinical pharmacy services were developed to minimize medication errors, adverse drug events and medical costs, but clinical pharmacy is still in its early stages in orthopaedics. WHAT IS NEW AND CONCLUSION A multidisciplinary approach should be adopted in the orthopaedic department, as pharmacist interventions can be vital for promoting the safety, effectiveness and cost-effectiveness of pharmacotherapy. Although pharmacists' contributions to orthopaedics are not yet fully recognized, pharmaceutical services can undoubtedly contribute to both clinical and societal outcomes.
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Affiliation(s)
- Chengxin Xie
- Faculty of Graduate Studies, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaoping Mu
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhuangming Hu
- Faculty of Nursing, Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Wang
- Faculty of Graduate Studies, Guangxi University of Chinese Medicine, Nanning, China
| | - Wenwen Huang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ge Huang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chenglong Wang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Dong Yin
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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